Do unexplained symptoms predict anxiety or depression? Ten-year data from a practice-based research network
Open accessAbstract
BACKGROUND: Unexplained symptoms are associated with depression and anxiety. This association is largely based on cross-sectional research of symptoms experienced by patients but not of symptoms presented to the GP. AIM: To investigate whether unexplained symptoms as presented to the GP predict mental disorders. DESIGN AND SETTING: Cross-sectional and longitudinal analysis of data from a practice-based research network of GPs, the Transition Project, in the Netherlands. METHOD: All data about contacts between patients (n = 16,000) and GPs (n = 10) from 1997 to 2008 were used. The relation between unexplained symptoms episodes and depression and anxiety was calculated and compared with the relation between somatic symptoms episodes and depression and anxiety. The predictive value of unexplained symptoms episodes for depression and anxiety was determined. RESULTS: All somatoform symptom episodes and most somatic symptom episodes are significantly associated with depression and anxiety. Presenting two or more symptoms episodes gives a five-fold increase of the risk of anxiety or depression. The positive predictive value of all symptom episodes for anxiety and depression was very limited. There was little difference between somatoform and somatic symptom episodes with respect to the prediction of anxiety or depression. CONCLUSION: Somatoform symptom episodes have a statistically significant relation with anxiety and depression. The same was true for somatic symptom episodes. Despite the significant odds ratios, the predictive value of symptom episodes for anxiety and depression is low. Consequently, screening for these mental health problems in patients presenting unexplained symptom episodes is not justified in primary care.
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Research has shown that somatic symptoms are associated with at least a 2-fold increase in the likelihood of having a depressive and/or anxiety disorder.
“research has shown that they are associated with at least a 2-fold increase in the likelihood of having a depressive and/or anxiety disorder (Kroenke et al., 1997; Janssens et al., 2010; van Boven et al., 2011; Groen et al., 2021).”
From Does the practice of mindfulness reduce somatic symptoms and COVID-19-related anxiety? A community-based survey (2022) · cites this paper as van Boven et al., 2011
The Summary reports an association between somatic symptoms and anxiety or depression, but gives odds ratios ranging from 0.69 to 3.02—not uniformly at least twofold. It reports a 3–4-fold higher risk specifically for patients with two or more symptom episodes, a qualification absent from the claim. (LLM, conf=0.89)
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- Authors
- van Boven, K., Lucassen, P., van Ravesteijn, H., Hartman, T. O., Bor, H., van Weel-Baumgarten, E., & van Weel, C.
- Affiliations
- Radboud University Medical Center (NL)
- Venue
- British Journal of General Practice
- Published
- 2011-06
- Volume
- 61
- Issue
- 587
- Pages
- e316-e325
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC3103694
- OpenAlex
- W2105939577
- Cited by
- 57
- References
- 33
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 6 · 2021: 5 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 6 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 4
- FWCI
- 2.19
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- unexplained symptoms, somatoform symptoms, somatic symptoms, anxiety, depression, mental disorder prediction, positive predictive value, primary care, mental health screening, transition projects
- MeSH terms
- Adolescent, Adult, Aged, Anxiety Disorders, Cross-Sectional Studies, Depressive Disorder, Humans, Longitudinal Studies, Middle Aged, Somatoform Disorders, Young Adult
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